Key performance indicators for pre hospital emergency Anaesthesia - a suggested approach for implementation.

BACKGROUND: Pre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform. AAGBI guidance from 2017 suggests the use of Key Performance Indicators (KPIs) to audit PHEA quality. The aim of this study was to develop KPIs for use in our service and evaluate their impact. METHODS: Using the AAGBI 2017 document as a guide we developed a list of ten auditable domains. Data for each case was extracted from the Electronic Patient Record (EPR) and a score assigned to each of the domains; one if the domain is achieved and zero if the domain is not achieved or if data is missing, giving a total score out of ten. This analysis is then presented as a colour-coded matrix alongside the score. Data were analysed monthly at our case review and governance meeting. The process was refined during the year and after 12 months a formal review of the KPI process occurred. RESULTS: Eighty-two cases were analysed. Domains with the highest percentage of achievement were: Indication 96%; Tube position confirmed 94% and Full AAGBI monitoring and Grade of view < 3 both 89%. The amount of missing data declined throughout the year. The results of the clinician survey showed that almost all respondents found the TVAA PHEA review process useful. CONCLUSION: The KPI process has demonstrated areas of good quality practice and led to improvements in equipment, processes and documentation and therefore patient care. We offer suggestions to other organisations considering implementing KPIs for PHEA.

Traumatic cardiac arrest: a unique approach.

Resuscitation of patients who sustain a cardiac arrest as a result of trauma (traumatic cardiac arrest) has previously been described as 'futile'. Several published series have since contradicted this claim and reported survival-to-discharge data ranging from 0 to 35%. International resuscitation guidelines (European Resuscitation Council and American Heart Association) promote a consistent approach to cardiopulmonary resuscitation on the basis of up-to-date evidence and consensus opinions. This minimizes de-novo decision-making under high-stress situations, promotes a rational approach and reduces the burden on an individual clinician. This narrative review sets out to highlight the differences in aetiology of traumatic cardiac arrest as compared with medical cardiac arrest and the consequent priorities in resuscitation.